Forms & Resources
Make a Referral to Harford Belair
Harford Belair Community Mental Health Center accepts clinician referrals to our psychiatric rehabilitation program and outpatient programs. Please use the forms provided to make a clinician referral to our Intake Department. Fax your completed form directly to (410) 426-5247. Form submission does not guarantee access to mental health services.
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Referrals/Forms
Haven PRP Referral
Refer a patient to our Haven Psychiatric Rehabilitation program.
Download PDF
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Referrals/Forms
HB Outpatient Referral
Refer a patient to our outpatient mental health services.
Download PDF
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Referrals/Forms
HB Mobile Treatment/Assertive Community Treatment Referral (ACT)
Refer a patient to our Mobile Treatment or Assertive Community Treatment Program.
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Referrals/Forms
HIPAA Notice of Privacy
Review our Notice of Information practices at Harford Belair.
Download PDF
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USDA Nondiscrimination Statement
Review our Nondiscrimination statement under federal civil rights law and USDA.
Download PDF
Helpful Resource Links
Maryland Medical Assistance Application (for minors)
PAC Application (for adults)
Baltimore City Core Service Agency
Office of Health Care Quality
Maryland State Vital Records
Baltimore Child and Adolescent Response System (B-CARS)
Baltimore City Crisis Response
MD Motor Vehicle Association
Social Security Administration
Baltimore City Department of Social Services
Department of Health and Mental Hygiene
Goodwill (Housing/Case management services)
Office of Health Care Quality
Maryland Division of Rehabilitation Services (DORS)
PAC Application (for adults)
Baltimore City Core Service Agency
Office of Health Care Quality
Maryland State Vital Records
Baltimore Child and Adolescent Response System (B-CARS)
Baltimore City Crisis Response
MD Motor Vehicle Association
Social Security Administration
Baltimore City Department of Social Services
Department of Health and Mental Hygiene
Goodwill (Housing/Case management services)
Office of Health Care Quality
Maryland Division of Rehabilitation Services (DORS)